ArticleFrontiers in public health2026
Temperature-related indicators and risk of incident cardiovascular-kidney-metabolic multimorbidity in middle-aged and older adults: a longitudinal cohort study from CHARLS.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To examine associations between temperature-related indicators and incident cardiovascular-kidney-metabolic (CKM) multimorbidity in middle-aged and older Chinese adults. Methods: We analyzed 4,665 CKM-free participants from the China Health and Retirement Longitudinal Study (2011-2018). CKM multimorbidity was defined as ≥2 conditions among cardiovascular disease, chronic kidney disease, and metabolic disorders. Exposures included 8-year mean temperature, persistent extreme cold events (≥5 consecutive days), and monthly temperature. Logistic regression, Cox models, a semi-Markov multistate model, and mediation analysis were used. Regional heterogeneity was tested via an interaction term between climate zone (cold/temperate/warm) and extreme cold events. Results: Over 7 years, 804 (17.23%) developed CKM multimorbidity. Each 1 °C increase in mean temperature was associated with 7.4% lower odds (OR = 0.926; 95% CI: 0.911-0.942), while each additional extreme cold event increased odds by 10.0% (OR = 1.100; 95% CI: 1.050-1.154). Higher monthly temperature reduced the hazard of transitioning from no CKM directly to complete CKM (HR = 0.905; 95% CI: 0.865-0.946), but not from partial to complete CKM. The effect of extreme cold events varied by climate zone: interaction was significant for temperate vs. cold zone ( Conclusion: Long-term low temperature and persistent extreme cold events are associated with higher CKM multimorbidity risk, particularly in early disease transitions and with significant regional heterogeneity. Findings support targeted cold-region interventions such as improved housing insulation and early warning systems.
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